So much going on in the sports world, including on the golf course, where Chad Ramey of Fulton became the first native born Mississippian to win on the PGA Tour in 52 years. This week, we’ve got both the men’s and women’s Final Fours and so much high level college baseball. The Cleveland boys talk about it all in this episode.
Stream all episodes here.
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Senior political reporter Bobby Harrison sat down with State Economist Corey Miller to talk about Medicaid expansion at the third and final Mississippi in the Know: Legislative Breakfast on Thursday, March 24. Miller, alongside Senior Economist at the Mississippi Institution for Higher Learning Sondra Collins, has recently published a study from the University Research Center analyzing the effects of Medicaid expansion on the state.
Editor-at-large Marshall Ramsey took the stage during the conversation to complete a live drawing that referenced the role Miller’s research has played in the tense 2022 legislative session.
Explore more Mississippi Today events.
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Mississippi’s largest hospital went out of network with the state’s largest insurer on Friday, meaning thousands of Mississippians will now face higher out-of-pocket costs for their health care or be forced to leave the state for certain specialty care.
This is the first time the state’s only academic medical center has officially gone out of network and not had an active contract with Blue Cross Blue Shield of Mississippi, according to UMMC officials’ knowledge.
Even though representatives for both sides have been meeting in person each week since January, the two entities were not able to agree to a new contract before the March 31 deadline.
UMMC is asking Blue Cross for substantial increases to inpatient, outpatient and professional reimbursement rates, some as large as 50%. UMMC maintains it’s asking for below market rates for academic medical centers, while Blue Cross officials say that steep rate hikes would necessitate a substantial increase in customer premiums.
“We are disappointed that Blue Cross doesn’t value the Medical Center enough to agree to a fair contract and keep us in its network,” Dr. LouAnn Woodward, vice chancellor for health affairs and dean of the UMMC School of Medicine, said in a press release. “We know that patients are disheartened and frustrated. We must – for the health and wellness of all Mississippians – stand firm in our resolve that Blue Cross should agree to pay us at fair market rates.”
The two sides have also sparred over Blue Cross’ quality care plan, which measures hospital performance and whether services provided to patients are adequate across 15 different categories. UMMC leadership has said that the complexity involved in the care the hospital provides means it should have an individualized quality care program, while Blue Cross maintains that UMMC should be held to the same standards as its other network providers.
“It is unfortunate we have not been able to reach an agreement,” said Cayla Mangrum, corporate communications manager at BCBSMS, in a statement. “Unreasonable demands by UMMC for increased payments, along with their unwillingness to agree to Network Hospital quality requirements, are not in the best interest of our Members and Groups as we seek to provide access to quality, cost-effective health care. We will continue to work to reach an agreement with UMMC, but until then, our primary goal remains our Members’ health.”
There are certain services and facilities UMMC has that cannot be found anywhere else in the state. These include Mississippi’s only Level 1 trauma center, Level IV neonatal intensive care unit and children’s hospital, among other critical care services.
Insurance Commissioner Mike Chaney told Mississippi Today this week that he questions whether BCBS could meet the state’s Managed Care Plan Network Adequacy Regulation without UMMC in its network. The regulation requires health insurance providers to “maintain a network that is sufficient in numbers and types of participating providers to assure that all devices to covered persons will be accessible without reasonable delay.”
Cheney also said his office would get involved if the two parties didn’t strike a deal by Friday.
This week, Mississippi Today spoke to parents whose children have been receiving specialty care at Children’s of Mississippi. Few have received answers about what the future holds and some are scrambling to find an alternative provider for their children.
“The truth is we can’t go anywhere else,” said Lanier Craft, whose son has Pompe disease, a rare genetic condition that affects the muscles. “This is all there is for us. Batson has been there since I walked in the door in February eight years ago with my child. They have done everything for us, and to just completely lose that within a day because of an agreement over money is unimaginable.”
There are three groups of Blue Cross Blue Shield customers that UMMC’s out-of-network status won’t apply to:
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UMMC will take BCBS of Mississippi — April Fool’s!
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Mike Feder arrived in Jackson in 1979 to become general manager of the Class AA Jackson Mets, which was the Class AA affiliate of the New York Mets from 1975 until 1990.
The historic Easter Flood decided to tag along. When the Texas League season began, Smith-Wills Stadium was submerged under Pearl River floodwaters.
“I’ve never seen so much rain,” Feder said. “It almost seems as if it never stopped raining. I’ve still got scars on my knuckles from pulling that tarp. We set a Texas League record for rainouts.”
Nevertheless, Feder spent the next nine years running the Jackson team.
“We had a lot of great players, a lot of great managers and coaches who came through on their way to the Big Leagues,” Feder said. “We won some championships and we had some fun.”
Those times will be re-lived this weekend when former players, coaches and managers will travel back to Mississippi for a Jackson Mets reunion. They’ll play some golf, wine and dine, tell some stories and have a meet and greet with fans Saturday morning at the Mississippi Sports Hall of Fame Museum (10 a.m.).
More than 30 former players, including several who made the Major Leagues, will attend. Those include Darryl Strawberry who as a 19-year-old Jackson Met slugged 34 home runs. That figure is especially impressive when you consider Strawberry played all his home games in a cavernous, often humid ballpark where home runs elsewhere were fly ball outs.
The ball sounded different coming off Strawberry’s bat – take it from someone who would go to the ballpark just to watch him take batting practice. His home runs often soared high into the pine trees beyond the right field fence, an area that became known as “The Strawberry Patch.”
In 1982, Strawberry, Billy Beane and Terry Blocker often manned the three outfield positions in the Jackson Mets lineup. All three were former No. 1 draft choices. Strawberry and Beane, who went on to become General Manager of the Oakland A’s and subject (played by Brad Pitt) of the hit movie “Moneyball,” are both expected to attend the reunion.
Strawberry went on to hit 335 Major League home runs. If that home run number surprised anyone who watched him in Jackson, it was only because he did not hit more.
One former Jackson Met who won’t have to travel far is Mike Howard, who lives in Gluckstadt. Howard met his wife here during his Jackson Mets days (1979-80) and returned to the Jackson area when his playing days ended. Any Jackson baseball fan from that era will fondly remember Howard, known as “Mad Dog” because of his relentless playing style. Mad Dog Howard ran to first base even after he walked or was hit by a pitch.
“People asked me why I would run to first after a walk,” Howard said. “I’d tell them I was just warming up so I could steal second and third base.”
Howard stole 55 bases over his two full Jackson Mets seasons. In 1980, when he was the Jax Mets MVP for a Texas League championship team, he hit .291 with 29 doubles and eight triples and seemed on a fast track to Shea Stadium in New York.
Howard did make it to New York but the stay was short. “You’ve heard of getting a cup of coffee in the Big Leagues?” Howard said. “I had time for two cups of coffee and a bagel.”
He played parts of the 1981, ’82 and ‘83 seasons for the New York Mets. On opening day of the 1983 season, Howard started in right field against the Philadelphia Phillies. Hall of Famer Steve Carlton was on the mound for the Phillies. Hall of Famer Tom Seaver was on the mound for the Mets. The Mets won 2-0. The switch-hitting Howard knocked in the winning run. As cups of coffee go, that one was sweet. And it got sweeter.
“So the next day it’s raining, and I go to the batting cage underneath the stadium to get some B.P., and somebody was already there. It was Pete Rose getting in some swings,” Howard said. “Well, Pete Rose was my childhood idol. So I introduced myself to him and he said, ‘Oh, I recognize you. You kind of have my playing style.’ I could have died and gone to heaven right then.”
Not nearly all the former Jackson Mets returning for the reunion made it to the Major Leagues. One who did not is Kurt Lundgren, who pitched three seasons (1985-87) at Smith-Wills. In ’85, Lundgren, a New York native and lifelong New York Mets fan, won eight games, lost four and had a 3.29 earned run average and was named the Mets’ most outstanding pitcher.
But Lundgren was not your typical professional baseball pitcher. For one thing, he was only 5 feet, 10 inches tall and weighed all of 170 pounds with his spikes on. He did not throw hard. What’s more, Lundgren was an Ivy Leaguer, a graduate of Columbia where he majored in English. He was a voracious reader, who would just as soon talk about William Faulkner and Eudora Welty as how he had pitched that evening. I know. That’s often what we talked about in the Jax Mets club house.
When his baseball career ended in 1987, Lundgren, who had no money, had to decide how to make a living. He chose to become a lawyer and enrolled in the Mississippi College School of Law.
“I loved it in Mississippi,” Lundgren said Thursday after arriving in Jackson Wednesday night. “I loved the food and the people. I loved how laid back the lifestyle was. In three summers, I had made some good friends here. It seemed like the thing to do. No regrets here.”
After law school, he moved back to New York where he has become a successful litigator, a partner in a successful firm. When he heard about this weekend’s reunion, there was never a doubt.
“Of course I was coming,” Lundgren said. “I can’t wait to see all the guys and see all my Mississippi friends, both from baseball and law school. It’s funny, you know, when I walked off that plane last night, I think my blood pressure went down 20 points.”
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House and Senate negotiators say they are still working to reach an agreement to restore the state’s initiative process that allows Mississippians to bypass the legislative process and place issues on the ballot for voters to decide.
Most of the focus as legislators strive to conclude the session either this weekend or early next week has been on developing a state budget and spending the bulk of $1.8 billion in federal COVID-19 relief funds. But negotiators said they are still working on fixing and restoring the initiative process that was ruled invalid this past May by the Mississippi Supreme Court.
When asked if a deal was still possible, Sen. John Polk, R-Hattiesburg, the lead Senate negotiator, replied “absolutely.”
Still, it appears the two sides are far from reaching agreement.
Both Polk and Rep. Fred Shanks, R-Brandon, the lead House negotiator, said the primary disagreement centers on the number of signatures needed to place an issue on the ballot. The House position is that the number of signatures should be equal to 12% of the people voting in the last gubernatorial election.
The Senate wants the number of signatures needed to place an issue on the ballot to be equal to 12% of the registered voters (not those voting) on the day of the last presidential election.
The required number of signatures of registered voters needed under the House plan would be about 100,000 while under the Senate proposal it would be about 240,000.
“I don’t see how a grassroots organization would be able to get that number of signatures,” Shanks said of the Senate proposal.
Polk said he supported the high number of signatures because “it makes sure more Mississippians (at the ballot box) care about the issue being presented.”
The state’s previous initiative process that was struck down by the state Supreme Court required the signatures equal to 12% of the voters from the last gubernatorial election. The Supreme Court struck down the proposal because the process required the mandated number of signatures to be gathered equally from the five congressional districts as they existed in 1990. The state lost a congressional seat in 2000.
The new language pending before the Legislature would require the signatures to be gathered equally from ever how many congressional districts the state has.
Both sides agree that the new proposal should allow voters to place issues on the ballot to change or amend general law. The initiative adopted in the early 1990s and that was struck down by the Supreme Court last year allowed voters to amend the state Constitution.
Legislative leaders said they would prefer the process be used to amend general law because it is more difficult to change the state Constitution. Changing the Constitution requires the approval of voters.
It is likely that any agreement also would prohibit legislators from changing any initiative approved by voters for two years except by a two-thirds vote of both chambers of the Legislature. Any compromise also might include language requiring initiative sponsors to detail how to pay for any proposal that will cost the state money.
The initiative process was struck down at the same time the medical marijuana initiative that was approved by voters in November 2020 was ruled invalid by the Supreme Court.
At the time House Speaker Philip Gunn asked Gov. Tate Reeves to call a special session the restore the initiative process. Reeves did not. Earlier this session legislators passed a bill legalizing medical marijuana but have been unable to agree on how to restore the initiative.
Any proposal passed by the Legislature to restore the initiative also must be approved by voters.
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A Tupelo couple is suing a north Mississippi hospital and its affiliates over an alleged balance-billing scheme that cost them nearly $50,000.
Balance billing is illegal under a state law passed in 2013. The law states that if a health care provider accepts payment from a health insurance company on behalf of a patient, the provider is prohibited from collecting any amount from the patient above their deductible, co-pay, or co-insurance amount.
For example, if a patient is billed $10,000 by their hospital the health insurance company pays the hospital $5,000, and the hospital cannot then try to collect the remaining $5,000 from the patient.
Though balance billing is illegal in Mississippi, it still happens, as many are still unaware of the state law.
In 2017, Chastity Woods needed dozens of non-elective medical treatments, including blood and iron transfusions, according to the lawsuit. She received these treatments from North Mississippi Medical Center (NMMC) in Tupelo and local clinics also owned by the hospital’s Delaware-based parent company, North Mississippi Health Services, Inc.
After receiving payment from Chastity’s insurer Health Cost Solutions, the providers returned to the Woods to demand nearly $50,000 in additional payments in 2018.
Unaware of Mississippi’s ban on balance billing, the Woods accepted a special “tax time deal” from the debt collectors in March 2019 that would reduce their bills by 20%. They then paid the bills by taking out a home equity line of credit, the suit states.
The Woods allege that the debt collector came back in October 2019 to demand an additional $8,936.05 – even after the Woods paid nearly $42,000 to the hospital and debt collector. The Woods allege that the debt collectors continued to harass them until they filed their lawsuit in Feb. 2020.
Chastity declined to speak to Mississippi Today for the story. Calls to their attorney were not returned. Bruce J. Toppin, chief legal officer at North Mississippi Health Services, told Mississippi Today that the company does not comment on pending litigation.
Though balance billing is against the law in Mississippi, some hospitals haven’t updated their business models since the law was passed, according to Roy Mitchell, executive director of the Mississippi Health Advocacy Program.
“We (Mississippi) have the highest rate of medical debt in the country. We have for years … And (balance billing) is all based on a business model that, unfortunately, some providers are still clinging to,” Mitchell said.
The ban on balance billing is largely toothless, with Insurance Commissioner Mike Chaney and Attorney General Lynn Fitch claiming they lack the statutory enforcement authority to take action against hospitals that break the law. This leaves patients like the Woods with no alternative to lengthy and costly lawsuits.
A legislative attempt to strengthen the balance billing law in 2019 would have required the attorney general’s office to enforce the law and establish binding arbitration to resolve any balance billing disputes between providers and patients. Though it was authored by then House Insurance Chairman Rep. Gary Chism, the bill never made it out of committee.
Chism told Mississippi Today in 2019 that lawmakers who were also medical professionals opposed the bill.
“They want to be able to get their money,” Chism said.
Because Chastity’s health insurance plan is not in NMMC’s network, the hospital would have received a higher reimbursement if she had used Stanley’s insurance, attorneys for the hospital say.
“The Woods took the cheap way out and wound up with significantly higher out-of-pocket costs as a result,” the attorneys wrote.
The Woods chose to use Chastity’s Health Cost Solutions plan instead of Stanley’s state employees plan because the former had a lower deductible. But Mississippi’s anti-balance billing doesn’t distinguish between types of networks. According to the law, as long as the provider accepts payment from the insurer, “the payment shall be considered payment in full to the provider, who may not bill or collect from the insured any amount above that payment, other than the deductible, coinsurance, copayment or other charges for equipment or services requested by the insured that are non-covered benefits.”
The Woods attorneys have argued that if the providers believed the reimbursement rates offered by Chastity’s insurer weren’t high enough, they could have refused to provide the non-emergency treatment or insisted the Woods find another way to pay. Instead, NMMC accepted at least 48 different payments from Chastity’s insurer, at 140% of the rate Medicare would have paid, the lawsuit alleges.
In addition to damages, the Woods are seeking a permanent injunction against NMMC issuing or attempting to collect balance bills.
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Reluctance to expand parole may have led Mississippi legislators to unwittingly sabotage an effort to save state money by shifting some incarcerated people’s health care costs to Medicaid.
The state’s prisons are overcrowded, and hundreds of prisoners are sick and elderly– the consequence of harsh mandatory sentencing laws that have led to large numbers of people growing old in prison for the first time in American history.
Though many of them are eligible for Medicaid coverage because of age or disability, the program won’t pay for health care provided inside institutions like jails and prisons, leaving Mississippi on the hook for expensive health care.
The state spent about $77 million on health care for people in prison custody in 2020, including $24 million on offsite care at hospitals. Just over 500 prisoners are older than 65, and research shows the cost of incarcerating an elderly person is about three times higher than a younger person because they have much more expensive health care needs.
House Bill 936 was approved by both chambers this week and is on its way to the governor for his signature. It aims to address prison health care costs by creating “special care facilities” that could serve as a home for some of the 600 Mississippians who have been paroled but have nowhere to go and so remain in Department of Corrections custody. The bill would also expand medical parole for “medically frail” incarcerated people to the private facilities, where supporters say Medicaid would help pay for care.
The legislation could put Mississippi at the vanguard of states experimenting with placing elderly, sick incarcerated people in nursing homes.
But there’s a wrinkle: Federal guidance issued in 2016 says Medicaid won’t pay for nursing care if residents’ freedom of movement is restricted or if the criminal justice system retains a role in their health care. Some provisions of HB 936 appear to run afoul of those rules, raising the possibility that Medicaid would refuse to pay for at least some parolees’ care at the facilities, forcing the state to keep paying.
The bill defines “medically frail” as people who are so ill that they can’t perform daily living activities and are not expected to recover. Those parolees must agree to have their medical records sent to a county prosecutor every quarter if the prosecutor requests them.
And in a provision that was added after the bill passed the House and included in the final conference report, the State Parole Board will revoke parole if the person recovers, “and the department shall ensure that the inmate returns to incarceration.”
Gov. Tate Reeves’ office did not respond to a request for comment on the legislation.
Dan Mistak, acting president and director of Health Care Initiatives for Justice-Involved Populations at the non-profit Community Oriented Correctional Health Services, said sending someone back to prison if their health improves seems to cross the line Medicaid has drawn.
“A revocation like that, it signifies that you’re still under control of the state,” Mistak said.
The provision requiring parolees to agree to share their medical records with prosecutors could also compromise “personal privacy and confidentiality” of clinical records, which is a right that facilities must respect if Medicaid is to pay for care.
“They’re trying to figure out a way to still keep people under their control while at the same time trying to cost-shift to the federal government,” Mistak added.
Rep. Otis Anthony, D-Indianola, is a member of the Corrections Committee and worked on the bill.
“In order to get it passed, sometimes the other house will put in some language that will appease, you know, voters who don’t want to see people paroled for anything,” he said. “So that’s probably one of those provisions that the Senate stuck in there to ensure that they will serve their time… But for the most part I don’t think that provision will ever be used. Very few terminally ill people who will need either long-term care or hospice care will ever recover.”
Bill author Rep. Kevin Horan, R-Grenada, said that if the Centers for Medicare & Medicaid Services (CMS) doesn’t approve reimbursement for parolees’ care at the facilities, legislators can revise the law accordingly.
“I’m not saying it is a work in progress moving forward, but we gotta get something on the books, see what CMS is gonna do,” he said. “We have to do something.”
The state’s existing conditional medical release policy is used rarely. Only three people were granted the release in 2021, following seven in 2020 and 10 in 2019, according to the Department of Corrections.
Horan emphasized that the revocation provision doesn’t apply to the Mississippians who have already been paroled but remain in MDOC custody. Their parole would not be contingent on their health status, Horan said.
Sen. Daniel Sparks, R-Belmont, focused on those people while presenting the conference report on the Senate floor Tuesday afternoon.
“They have nowhere to go,” Sparks said. “Their family may have died. But they’re in MDOC. Which is a problem for us as a state. We are paying for their medical, we are paying for their housing.”
Even if Medicaid doesn’t pick up the tab at the special care facilities, the bill will save Mississippi money because paying for nursing care is cheaper than repeatedly sending a person to the hospital and paying for separate services, Sparks said on the Senate floor.
Sen. Angela Burks Hill, R-Picayune, questioned Sparks about how much the legislation would cost the state. Sparks said it would save money, but he couldn’t say how much.
Hill said she wanted to see such an estimate “before we commit to this Medicaid expansion.”
“Because that’s what it is,” she said. “It’s Medicaid expansion for prisoners and parolees.”
Hill and 15 other senators voted against the conference bill.
Many Republicans who don’t support expanding Medicaid for working-poor Mississippians voted in favor of HB 936. Sen. Brice Wiggins, R-Pascagoula, sponsored a separate bill, SB 2448, that would have also created the “special care facilities” for medically frail inmates. In an interview with Mississippi Today, he declined to explain why he doesn’t support Medicaid expansion in general.
His bill passed the Senate with broad support before dying in the House Medicaid Committee. Wiggins also participated in the conference on HB 936.
The legislation makes Mississisppi part of a growing wave of states trying to figure out ways to use Medicaid to help reduce the costs of providing health care for incarcerated people.
Mistak said Mississippi is unusual because most states that have pursued that goal expanded Medicaid eligibility based on income. That creates greater potential savings, because it makes almost every incarcerated person eligible. Then the program will pay for care that requires a hospital stay of at least 24 hours.
There’s still not much precedent in other states to show how exactly Mississippi’s program would play out if enacted. In Connecticut, a nursing home called 60 West houses people paroled from prison following a 2013 law. But Medicaid initially refused to reimburse Connecticut for parolees’ care there, citing the presence of security measures that had no medical justification. After the facility made changes, Medicaid agreed to pay. Today, 60 West looks like any other nursing home.
David Skoczulek, vice president of business development at iCare Health Network, which operates 60 West, told Mississippi Today that a handful of 60 West residents have returned to prison after violating a term of their parole. But no one living at 60 West can be returned to prison simply because their health improved.
“It would seem to be extraordinarily difficult to protect resident rights in a way that conforms with CMS rules and requirements if they still require the types of custody precautions of a current prisoner,” he said.
The facility does not share medical records with anyone in the corrections or justice system, he added.
HB 936 would also create regulations for the special care facilities, and stipulates that there can be no more than three in each Supreme Court district. MDOC would be responsible for contracting with the facilities and would regulate them along with the Department of Health.
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Brittany Brown of Madison was on the way to a photo shoot for her newborn son when she got a phone call from the state health department. There was something abnormal in her baby’s newborn screening.
Since that day a year and a half ago, Brown and her husband have lived in uncertainty. Their son was diagnosed with Pompe disease, a rare genetic condition that causes muscle weakness and progressively gets worse.
The first uncertainty came after the call: What is Pompe disease?
“I’ve never had a feeling like that,” she said. “… there’s no comparison to getting a call and Googling something like that and thinking that’s what your situation is when you thought you just birthed a healthy child.”
The Google search produced even more uncertainty. There were two types of Pompe Disease, one more severe than the other, she learned. Which did he have?
“We lived in this limbo for a few weeks waiting to find out what kind he had,” Brown recalled.
Her days now are devoted to making sure her son doesn’t fall behind in his specialist appointments and twice-monthly, $20,000 infusions that ensure he is able to walk, swallow and perform other basic tasks. His weekly visits to a physical therapist and an occupational therapist are critical, and his doctors keep a close eye on his health – any regression that goes unaddressed could quickly become permanent.
And in recent weeks, she’s been dealing with yet another unknown.
The University of Mississippi Medical Center, where her now 18-month-old sees a slew of specialists and therapists and receives his life-saving medicine, is battling with her family’s insurance company, Blue Cross Blue Shield. If the two don’t reach an agreement by Friday, UMMC will go out of network with the company – meaning Brown and her husband could face massive bills or be forced to go out of state for their son’s care.
Brown, and many other patients who either can’t or won’t go elsewhere, have not been able to get an estimate from the hospital of what their out of pocket costs would be if they continued with their UMMC providers. Brown said her son’s UMMC therapists are so wonderful, and so hard to get in with, that she is considering paying out of pocket to keep her son’s spot.
But she said she’s been told they can’t give her any idea of what the costs would be until after UMMC is officially deemed out of network with the insurance company.
Brown’s son is one of tens of thousands of Mississippians who will be impacted if UMMC and Blue Cross Blue Shield don’t settle on the terms of their contract. The dispute between the two stems from disagreement over reimbursement rates and Blue Cross’ quality care plan, which measures hospital performance and whether services provided to patients are adequate.
The public battle is a classic he-said, she-said: UMMC officials say they are only asking for the insurance company to reimburse at “under market rate” prices compared to other academic medical centers. Blue Cross leaders see it a different way.
“Blue Cross & Blue Shield establishes payment rates on the market rate for Mississippi, not what out-of-state providers are paid,” said Cayla Mangrum, manager of corporate communications for Blue Cross Blue Shield of Mississippi. “UMMC is asking for an overall 30% increase for all of its hospitals and all of its providers. Think about it this way: UMMC is asking that a nurse practitioner in a UMMC Clinic in every city in the state be paid more than every non-UMMC nurse practitioner. UMMC is asking that a physician at UMMC – Grenada be paid more than the physician at any Baptist hospital …”
But those at UMMC maintain their physicians should be treated differently than other hospitals. UMMC treats the sickest of the sick and is home to the only children’s hospital, the only Level 1 trauma center, and the only organ, tissue and bone marrow transplant program in the state.
“Blue Cross wants to compare us to other Mississippi hospitals, but there are no hospitals in the state like us,” said Dr. LouAnn Woodward, vice chancellor for health affairs and dean of the School of Medicine. “Every day we treat patients across Mississippi, many with nowhere else to turn, because they need the specialty physicians found only here at UMMC.”
But for the Mississippians who rely on those specialized services, disagreements between hospital and insurance executives don’t mean much to them. Their concern is how and whether they and their children will receive life-saving care without going bankrupt – and leaders at both UMMC and Blue Cross are aware of that.
“Unfortunately the patients are caught in the middle of this dispute,” said Dr. Alan Jones, associate vice chancellor for clinical affairs at UMMC.
Lanier Craft of Brandon also has a son with Pompe disease. For eight years, beginning with his diagnosis at three months old, mother and son have trekked to UMMC for appointments with specialists in Ear, Nose and Throat, complex care, cardiology, pulmonology, orthotics, ophthalmology, neurology and surgery.
Her son Townes receives the same infusions of medicine as Brown’s son – except he gets them weekly. Townes is also wheelchair bound, has a tracheostomy tube and is on a ventilator – making the prospect of regular trips three hours away to New Orleans, Birmingham or Memphis even more daunting.
“The truth is we can’t go anywhere else,” said Craft, crying. “This is all there is for us. Batson has been there since I walked in the door in February eight years ago with my child. They have done everything for us, and to just completely lose that within a day because of an agreement over money is unimaginable.”
Craft, a teacher, said the past week has been a frenzy. Her son has always been on her husband’s commercial plan, and if she tried to switch him to her state plan, he would either not be accepted because of a pre-existing condition or be extremely expensive.
She took half a day off work Tuesday to make phone calls: to doctors; Blue Cross Blue Shield of both Mississippi and Tennessee, the state her family has insurance through; the insurance commissioner; and any connections she has with offices and agencies who might help.
The calls got her nowhere, she said – a similar outcome reported by others who spoke to Mississippi Today. Several reported they would call UMMC’s help line only to be told to call Blue Cross. Blue Cross would then tell them they would have to call UMMC.
Around 2 a.m. Wednesday morning, Craft was awake with her son, who was struggling to maintain healthy oxygen levels. Waking in the middle of the night to tend to a health issue with the eight-year-old is common for her.
“My first thought was ‘I can’t take him to the hospital, I don’t know if he’s going to be covered,’” she said. “The first thought as a parent (in that situation) should not be ‘How am I going to afford this?’”
The fallout between the insurance company and the state’s only safety net hospital does not just impact Mississippians with rare, complex conditions.
One mom of four who spoke to Mississippi Today but did not wish to use her name in the story has spent the last three months fighting to figure out why her daughter is so sick.
After an eight-day hospital stay and a diagnosis of Kawasaki Disease last year, her daughter began developing unexplained sores. Despite multiple treatments recommended by specialists at Children’s of Mississippi, they didn’t improve. Her hair began falling out and she lost weight.
Her daughter’s pediatrician and UMMC dermatologists ran tests for various infections, but all came back negative. The doctors last week directed her to Children’s of Mississippi for a biopsy.
She scrambled to get her daughter in for the procedure before Friday, April 1, when UMMC will be considered out of network. It is scheduled for Thursday – just one day before the deadline for a contract agreement.
But regardless of the biopsy results, her daughter will still need care at UMMC – and the insurance dispute has added another layer of stress to an already stressful situation, she said.
“We will do whatever we need to do, but we only have so much savings,” she said, noticeably emotional. “One of her bills was $79,000 from when we were in the hospital… and Blue Cross paid $78,000 of that. So what else are we supposed to do?”
Because Blue Cross and UMMC have had similar public disputes in the past, some patients remain unphased, believing they will work it out as they have done before.
But while Blue Cross and UMMC disagree on a lot, they both agree on one thing: the chances of this getting worked out before April 1 are slim.
“We at UMMC don’t believe it’s going to get worked out,” Jones told Mississippi Today on Tuesday. “We’ve seen no good faith effort by Blue Cross to try to negotiate with us.”
Leaders at the insurance company said they are “not optimistic” an agreement will be reached before the deadline, but maintain they have been working to reach an agreement with the hospital.
“The fact we have not agreed to their reimbursement or quality demands does not mean we have not acted in good faith,” said Mangrum. “Since early 2021, we have had a dedicated team meeting with UMMC personnel and evaluating the financial impacts of reimbursement demands as well as quality improvement programs under which UMMC could have received additional payments if they met certain criteria.”
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